This document discusses evidence-based medicine (EBM) and its importance for family physicians. It defines EBM as integrating individual clinical expertise with the best available clinical research evidence to make decisions about patient care. The five steps of the EBM process are outlined as asking questions, accessing evidence, appraising the evidence, applying to practice, and auditing performance. While EBM has advantages like improving quality of care, there are also challenges for family physicians in applying it due to limitations of evidence and time constraints. EBM must be implemented thoughtfully while balancing different types of evidence and the realities of family medicine.

1. EVIDENCE BASED MEDICINE
BY
MOHAMMED LUKMAN ABOLAJI
FAMILY MEDICINE,AKTH
KANO.
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2. SYNOPSIS
• INTRODUCTION
• PURPOSE
• RATIONALE
• STEPS IN THE EBM PROCESS
• ADVANTAGES OF EBM
• LIMITATIONS OF EBM
• CHALLENGES OF EBM
• CONCLUSIONS
• REFRENCES
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3. INTRODUCTION
• FP need to do a lot more than merely update their knowledge, yet they
are drowning in information. The current knowledge explosion and rapid
advances in diagnostics and therapeutics are cause for concern.
• There is no logical means to choose what to read unless you use a
systematic way of reading.
• FM is not confined to knowledge of a particular group of diseases and
requires a breadth of knowledge and skills that are particularly
challenging.
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4. INTRODUCTION
• A FP will always encounter patients with stimulating questions pushing
the boundaries of current practice.
• There are always new approaches to care, new roles for the FP (as
capacity builder, leader of clinical governance, champion of community
orientated primary care, supervisor of students) and new skills to
learn(e.g use of information technology).
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5. INTRODUCTION
The following trends may develop in future:
• Patients will be increasingly well informed
• Patients with diseases will be members of support groups that provide
high-quality information
• Patients will increasingly want involvement in shared decision making
• The disease spectrum will change
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6. INTRODUCTION
• There will be a need for teaching patients and FP how to cope with
uncertainty
• Diagnostic activities will become more sophisticated and equipment will
become more portable
• FP will be held more and more accountable to their patients and their
profession and will need to undergo further forms of re-certification and
re-accreditation.
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7. INTRODUCTION
• EBM Is the process of integrating individual clinical expertise with best
available clinical evidence from systematic research for the purpose of
making decisions about the care of individual patients
• EBM is the integration of best research evidence with clinical expertise and
patient value.
• When confronted with the great responsibility of understanding and treating
human beings we need as much scientific evidence as possible to render our
decision making valid, credible and justifiable.
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8. READER – AN ACRONYM TO AID
CRITICAL READING BY FAMILY
PHYSICIANS
• Relevance: Is it about family medicine?
• Education :Does it challenge my knowledge?
• Applicability: Does it apply to my situation?
• Discrimination: What is the scientific quality of the article?
• Evaluation: What is my evaluation, based on the above criteria?
• Reaction :How can I use this information?
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9. PURPOSE OF EBM
• The public is becoming more and more informed and is increasingly
more proficient in searching for information on the Internet.
• They may demand more explicit accountability and may insist that FP
base their decision-making in practice on sound, valid,
contemporaneous, relevant, and accessible external clinical evidence
• The skill of critical appraisal of published evidence for its closeness to
the truth, practical relevance, usefulness, and applicability. By engaging
with evidence so as to be able to make sound, evidence-based decisions
within family practice becomes mandatory.
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10. PURPOSE OF EBM
• EBM is all about quality – in finding the studies that address a particular
question, in only selecting studies of acceptable quality, in distilling the
information into knowledge, and in making the knowledge
understandable.
• When the knowledge is combined with a FP’s education and experience
and their knowledge of a patient and the values of people and society,
in order to make sound decisions.
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11. PURPOSE OF EBM
• EBM is a method of problem-solving that:
 Recognises that no individual person can know all that is needed to
practise effectively across the spectrum of care
 Acknowledges that not all therapies or health-care decisions that are
used have been validated
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12. RATIONALE FOR EBM
• FP act as witnesses to their patients’ suffering, interpreters of their
stories, and guardians against the over medicalisation of their problems.
• They often have to carry out these tasks when the evidence for diagnosis
and rational treatment is unavailable, absent, invalid, unreliable, or
irrelevant.
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13. RATIONALE FOR EBM
• Decisions will have to be made explicitly and publicly, and those who
make decisions will have to produce and describe the evidence on which
each decision is based. It is hoped that this will encourage a transition
from opinion-based decision-making to evidence-based decision
making.
• Relevant research refers to whether there is sound, valid, and current
research evidence available to support what is being offered to the
patient in the form of a diagnostic test, therapeutic intervention, or
advice on prognosis.
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14. RATIONALE FOR EBM
• The best research evidence can be quantitative or qualitative and will
depend on the question asked.
 Quantitative evidence includes relevant patient-centred clinical research
into the accuracy of diagnostic tests, the power of prognostic markers,
the efficacy and safety of treatment regimens, and the effectiveness of
clinical interventions.
 Qualitative evidence on the other hand best describes the meaning of
illness or patient experiences, understanding, attitudes, and beliefs.
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16. STEPS IN THE EBM PROCESS
• The EBM process has five steps (the 5 As approach):
• Asking: Identify knowledge gaps and convert needs for clinical
information into focused answerable questions
• Accessing: Accessing the best evidence with which to answer the
questions
• Appraising: Critically appraising the evidence for its validity, importance,
and usefulness
• Applying: Applying the result of the critical appraisal in your practice
• Auditing: Auditing your performance in practice.
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17. ADVANTAGES OF EBM
• It allows for greater efficiency and quality of decisions
• It reduces the gap between research and clinical practice
• It improves family physicians’ understanding of research and its methods
• It improves computer literacy and data-searching skills
• It attempts to diminish uncertainty
• It provides a common language for critical appraisal
• It promotes self-directed learning
• It promotes effective and efficient family physicians
• It is presented in synopsis form as protocols and guidelines
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18. LIMITATIONS OF EBM
• The lack of time availability in primary care and the restricted resource
allocations are important reasons for the slow uptake of the principles
and philosophy of EBM.
• A vast array of unsolicited guidelines purporting to be based on
evidence is becoming available.
• Wealth of topics and problem areas where evidence is missing,
inconclusive or based on less robust research methodologies.
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19. CHALLENGES OF EBM
• There are obvious difficulties involved in integrating EBM into FM
medicine. The sheer volume of evidence available in the form of clinical
guidelines is increasing and becoming unmanageable.
• The FP may lack the necessary skills and time to access and interpret
the available evidence.
• FM is characterized by particular emphasis on the doctor–patient
relationship and on biomedical, personal, and contextual perspectives in
diagnosis .
• EBM predominantly addresses the biomedical perspective of diagnosis
and principally from a doctor-centred paradigm
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20. CHALLENGES OF EBM
• Emphasis on the biomedical perspective and the RCT, which is often
seen as the gold standard of EBM, fails to do justice to the realities of
FM, which is influenced by the subjective, anecdotal, patients’ stories of
illness and personal experience.
• Research evidence dealing with quality of life measures, meaning, and a
deeper understanding of patients’ and doctors’ attitudes is less readily
available.
• Personal experience and qualitative research are often characterized as
being a poor basis for making a scientific decision.
• However, they are often more persuasive than scientific publications in
changing clinical practice.
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21. CONCLUSION
• The time may come when health authorities require a minimum
acceptable level of evidence-based decisions by FP and when failure to
adhere to highly authoritative evidence-based systematic reviews or
clinical guidelines will be deemed negligent.
• FP have a responsibility to accommodate EBM as a desirable feature of
good practice. Patients have a right to receive medical opinions based,
when possible, on the best available evidence.
• The message, however, is clear that reading, interpreting, and acting on
published literature should become a routine part of clinical practice.
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22. REFERENCES
• Elwood M (1998) Critical Appraisal of Epidemiological Studies and
Clinical Trials (2nd edition).Oxford: Oxford University Press.
• Gabbay M (1999) The Evidence-based Primary Care Handbook. United
Kingdom: The Royal Society of Medicine Press Limited.
• Jones R & Kinmonth A-L (1995) Critical Reading for Primary Care. New
York: Oxford University Press.
• Muir Gray JA (1997) Evidence-based Healthcare. How to make Health
Policy and Management Decisions. New York: Churchill Livingstone.
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